Mixing Opioids and MAOIs

Mixing Opioids and MAOIs calls for caution — TripSit rates this combination “Caution.” Low risk never means safe.

Coadministration of monoamine oxidase inhibitors (MAOIs) with certain opioids has been associated with rare reports of severe and fatal adverse reactions. There appear to be two types of interaction, an excitatory and a depressive one. Symptoms of the excitatory reaction may include agitation, headache, diaphoresis, hyperpyrexia, flushing, shivering, myoclonus, rigidity, tremor, diarrhea, hypertension, tachycardia, seizures, and coma. Death has occurred in some cases.

Opioids (also known as heroin, fentanyl, oxycodone, morphine, methadone) and MAOIs (also known as some antidepressants, syrian rue).

What to do

• Even for lower-risk pairs, the safest choice is not to mix — and never to use alone.
• Keep naloxone (Narcan) within reach. It reverses opioid overdose and is safe to give if you are unsure.
• Start with much less than usual and go slow — you can always take more, never less.
• Never use alone. If you do, call 1-800-484-3731 (Never Use Alone) so someone can send help if you stop responding.

Open the interactive combination checker

Related combinations

• Mixing Opioids and Benzodiazepines
• Mixing Opioids and Alcohol
• Mixing Opioids and Cocaine
• Mixing Opioids and Amphetamines
• Mixing Opioids and MDMA
• Mixing Opioids and Cannabis
• Mixing Opioids and Ketamine
• Mixing Opioids and GHB / GBL

This is educational information, not medical advice. "Low risk" never means "safe", and the potency of an unregulated supply is unknown.